Information Collection

MyPlate Parent/Student REV

IC 202026 under ICR 201008-0584-001 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B - Parent Letter_Response Form_Consent Form for Parent_Consent Form for Student_ENGLISH_SpanishApril20.docx	Other-Attachment B - Parent Letter_R
Attachment D1 - Pre-Test Survey Instrument for Students_March13r.doc	Other-Attachment D1 - Pre-Test Surve
Attachment D2 - Post-Test Survey Instrument for Students_March13r.doc	Other-Attachment D2 - Post-Test Surv
Attachment E - Moderator's Guide for Parent Focus Group_MyPlate at Home Handout_ENGLISHMarch_13r.docx	Other-Attachment E - Moderator's Gui
MyPlate OMB Proposal_march22.docx MyPlate Generic Clearance Memo	IC Document
MyPlateTakehome-FINAL-3-7-12.pdf MyPlate Brochure English	IC Document
MyPlateTakehomeSPANv2-Final Spanish-3-7-12.pdf MyPlate Brochure Spanish	IC Document

IC Title:

MyPlate Parent/Student REV

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Attachment B - Parent Letter_Response Form_Consent Form for Parent_Consent Form for Student_ENGLISH_SpanishApril20	Attachment B - Parent Letter_Response Form_Consent Form for Parent_Consent Form for Student_ENGLISH_SpanishApril20.docx	No	Paper Only
Other-Attachment D1 - Pre-Test Survey Instrument for Students_March13r	Attachment D1 - Pre-Test Survey Instrument for Students_March13r.doc	No	Paper Only
Other-Attachment D2 - Post-Test Survey Instrument for Students_March13r	Attachment D2 - Post-Test Survey Instrument for Students_March13r.doc	No	Paper Only
Other-Attachment E - Moderator's Guide for Parent Focus Group_MyPlate at Home Handout_ENGLISHMarch_13r	Attachment E - Moderator's Guide for Parent Focus Group_MyPlate at Home Handout_ENGLISHMarch_13r.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA/FNS-8, FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	98	98
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MyPlate Generic Clearance Memo	MyPlate OMB Proposal_march22.docx	04/23/2012
MyPlate Brochure English	MyPlateTakehome-FINAL-3-7-12.pdf	04/23/2012
MyPlate Brochure Spanish	MyPlateTakehomeSPANv2-Final Spanish-3-7-12.pdf	04/23/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.